Keep It Clean for Kids: The KICK Project Healthcare-associated infections (HAIs) are the leading cause of morbidity and mortality in long term care facilities (LTCF) and are responsible for nearly 400,000 deaths each year in this population. Children in pediatric LTCF represent a highly vulnerable patient population with numerous co morbid conditions at high risk of contracting HAIs caused by multidrug-resistant organisms as well as by viral pathogens. Although such infections have been the focus of mainstream media attention, little empirical research has been conducted to prevent HAIs in LTCF, particularly in pediatric LTCF. The goal of this study is to reduce HAIs in pediatric LTCF by improving the patient safety climate and infection prevention practices. Specific aims of this study are to: 1. Describe the rates and types of healthcare-associated bacterial and viral infections in pediatric long term care facilities; 2. Assess the impact of a theoretically-based group-level behavioral intervention on rates of HAIs in pediatric long term care facilities (primary outcome); 3. Measure the impact of a theoretically-based group-level behavioral intervention on the number of outbreaks, antimicrobial utilization in patients, hospitalizations of patients, staff absenteeis (secondary clinical outcomes); and 4. Examine the impact of a theoretically-based group-level behavioral intervention on hand hygiene frequency using an innovative automated monitoring and feedback system to provide real-time feedback, and patient safety climate (secondary process outcomes). Three pediatric long term care facilities (284 beds) in the greater NYC metropolitan area will be included in a multi-disciplinary intervention, Keep It Clean for Kids (KICK) Project, modeled after the WHO interventions, the actionable feedback model, and a successful program from acute care. The KICK Project includes five key components: explicit leadership commitment, active participation of the staff, conducting work flow assessments, staff training in the WHO '5 Moments for Hand Hygiene' and electronic monitoring and feedback of hand hygiene. KICK teams comprised of clinical and administrative leaders will plan and implement changes. An interrupted time series analyses of the primary outcome (rates of HAIs) and secondary outcomes will be conducted. PUBLIC HEALTH RELEVANCE: Children in pediatric long term care account for 40% of all medical expenditures for children overall and represent a vulnerable patient population at high risk of contracting healthcare-associated infections caused by multidrug-resistant organisms and viral pathogens. Despite this, there has been minimal attention to the prevention of infections in this group. This study will be the first to provide vital information about rates and types of infections in these children and to test an intervention that will be generalizable to multiple chronic care facilities to reduce epidemic and endemic infections.